Effectiveness of using Haemoglobin A1c as a criterion to define metabolic syndrome in Chinese population

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Effectiveness of using Haemoglobin A1c as a criterion to define metabolic syndrome in Chinese population


Author: Yuen, Shuk Mei
Title: Effectiveness of using Haemoglobin A1c as a criterion to define metabolic syndrome in Chinese population
Degree: M.Sc.
Year: 2013
Subject: Metabolic syndrome.
Glycosylated hemoglobin.
Hong Kong Polytechnic University -- Dissertations
Department: Dept. of Health Technology and Informatics
Pages: xiii, 103 leaves : ill. ; 30 cm.
Language: English
InnoPac Record: http://library.polyu.edu.hk/record=b2637216
URI: http://theses.lib.polyu.edu.hk/handle/200/7056
Abstract: Metabolic syndrome (MS) is a cluster of metabolic abnormalities closely related to diabetes mellitus (DM) and cardiovascular disease (CVD) which are common non-communicable disease (NCD) found in developed and industrialized countries. MS is characterized by a cluster of conditions including hyperglycaemia, dyslipidaemia, abdominal obesity as well as high blood pressure. MS is now affecting about one-fourth of adults in worldwide. An effective detection of MS not only reflects the prediction risk of the aforementioned NCDs but also helps in planning of management strategy in the future which would be probably reducing the medical burden of the society. The objective of this dissertation was to work out the feasibility of using Haemoglobin A1c (HbA1c), a common but inexpensive test, which is used to monitor diabetes treatment to substitute fasting plasma glucose (FPG) as the dysglycaemic component to define MS and the possibility to increase the detection rate of MS in our population. HbA1c was chosen because of its higher reproducibility and lower biological variation comparatively to FPG. In this study, HbA1c≧5.7% would be used as the criterion of MS. Total 240 whole blood samples from a blood screening campaign were analyzed for HbA1c was measured by ion exchange high performance liquid chromatography method. After reviewing the basal characteristics of all participants, 11 of them were found with undiagnosed DM (FPG ≧7.0mmol/L) who were excluded for analysis. The most prevalent components in all included participants were high blood pressure (systolic blood pressure) and increased waist circumference. For HbA1c result, there was no significant difference in metabolic syndrome positive (MS+) group by age but higher HbA1c level seen with older age in metabolic syndrome negative (MS-) group. The correlation of FPG and HbA1c showed R=0.569 (p<0.001) and R=0.397 (p<0.001) in MS+ and MS- groups, respectively. The diagnostic property of HbA1c in MS detection using FPG criterion was evaluated by the receiver operating characteristics (ROC) curve, indicating that the area under the ROC curve analyses was 0.807 (95%CI 0.727 to 0.887). The agreement was 90.7% in MS+ group with increased FPG as one of the criterion co-existed with elevated HbA1c. The chi-square by McNemar test between FPG and HbA1c in MS+ group was 38.1 with significance (p<0.001). If including HbA1c as an extra criterion in MS definition, 30 more participants in MS- group would be defined with MS leading to the detection rate increased from 47.6% to 60.7%. Those participants using this criterion were generally older. From the results, there were 47 participants (38 from MS+ group and 9 from MS- group) were found having HbA1c≧6.5%. According to the new diagnostic criteria implemented by the expert group in 2009, these 47 participants would have been diagnosed with diabetes. Consistent with the hypothesis of this study, the potential application of HbA1c might help to find hidden diabetes in our population.

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